Date:
Patient:
Reason for Visit:
Follow-up for renal artery stenosis (RAS)
Assessment of blood pressure control and renal function
Evaluation for symptoms or progression of stenosis
Management plan discussion
History:
Presenting Illness:
Date of initial RAS diagnosis
Degree of stenosis on initial imaging
Presence of associated conditions (e.g., atherosclerosis, fibromuscular dysplasia)
Current symptoms (e.g., hypertension, fatigue, flank pain)
Past Medical History (PMH):
Underlying medical conditions (e.g., hypertension, coronary artery disease)
Prior interventions for RAS (angioplasty, stenting, bypass surgery)
Family History:
History of cardiovascular disease in first-degree relatives
Social History:
Smoking history (major risk factor)
Physical Exam:
General: Assess for signs of hypertension, malnutrition (fatigue), or abdominal bruits (may suggest severe stenosis).
Blood Pressure: Evaluate for hypertension (a cause and consequence of RAS).
Diagnostic Tests (may be ordered depending on clinical presentation):
Laboratory Tests:
Serum creatinine and electrolytes – Assess kidney function, may show abnormalities with severe stenosis.
Renin activity and aldosterone levels – May be elevated in some cases of RAS.
Imaging Studies:
Renal artery Doppler ultrasound: Non-invasive, readily available, provides estimates of stenosis severity.
Renal angiography: Definitive imaging for evaluating RAS location, degree of stenosis, and involvement of renal artery branches. May be performed with CT scan (CTA) or magnetic resonance angiography (MRA).
Assessment:
Degree of stenosis: Compare to previous imaging or estimates to assess stability or progression.
Blood pressure control: Evaluate response to medications and impact of RAS on hypertension.
Kidney function: Assess for evidence of renal dysfunction secondary to RAS.
Presence of symptoms: Evaluate for hypertension, fatigue, or flank pain.
Risk of complications: Based on stenosis severity, presence of symptoms, and kidney function. Potential complications include renal failure, heart attack, and stroke.
Management plan:
Medical management: Lifestyle modifications (diet, exercise, smoking cessation) and medications for blood pressure control and cholesterol management.
Percutaneous transluminal renal angioplasty (PT angioplasty) with stenting: Minimally invasive procedure to open the narrowed artery using a balloon and stent (for appropriate cases).
Bypass surgery: Surgical creation of a new passage for blood flow around the stenosis (less common approach).
Plan:
Management approach based on assessment:
Medical management: Optimize blood pressure control and address risk factors.
Referral to a vascular surgeon or interventional radiologist: If PT angioplasty or surgery is considered.
Laboratory monitoring: Monitor kidney function and electrolytes with appropriate frequency.
Imaging follow-up: Repeat imaging studies (ultrasound or CTA/MRA) at defined intervals to monitor stenosis severity.
Patient education: Provide information about RAS, risk factors, potential complications, and treatment options.
Discuss the importance of medication adherence, healthy lifestyle modifications, and regular follow-up.
Follow-up:
Schedule for follow-up appointments based on severity:
More frequent visits for patients with uncontrolled hypertension, worsening kidney function, or on active medical management.
Less frequent visits for patients with well-controlled RAS and stable kidney function.
Emphasize the importance of reporting any new symptoms promptly.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of renal artery stenosis.